What each model actually is
Concierge medicine came first. A practice charges patients an annual retainer for enhanced access and amenities, keeps a reduced panel, and in most cases continues to bill insurance for the clinical services themselves. The retainer buys availability, longer appointments and personal attention. It sits on top of your existing coverage rather than replacing any part of it.
Direct primary care emerged later with a different intent: strip out insurance billing for primary care entirely, price the membership low enough to be a mainstream option, and pass the administrative savings to the patient. The membership is the whole payment for included primary care rather than a surcharge on top of billed care.
| Concierge medicine | Direct primary care | |
|---|---|---|
| Typical fee structure | Annual or monthly retainer, often substantial | Modest monthly membership |
| Insurance billing for visits | Usually still billed | Usually not billed for included care |
| Positioning | Premium service tier | Affordable access and price transparency |
| Panel size | Reduced | Reduced |
| Who it targets | Patients willing to pay a premium for a private relationship | Uninsured, high-deductible and cost-conscious households |
Why the difference matters to your wallet
In a concierge arrangement you are paying twice in a sense: the retainer for access, and then your normal insurance cost-sharing for the visits themselves. That can be entirely reasonable if the access is what you want and coverage is not a strain. It is a poor fit if the underlying problem you are solving is that care already costs too much.
In direct primary care the membership is intended to be the price of primary care. There is no copay for included visits because there is nothing to copay against. For an uninsured household or one on a high-deductible plan, this is the practical difference between a model that adds a cost and a model that replaces one.
Where Presence sits
Presence is a direct primary care and telehealth membership, not a concierge practice. Virtual Family Care starts at $19.99/month for the household, and Virtual + Local In-Office Care is $29.99/month for the household. Individual Unlimited is age-based at $79, $89 or $109/month; Family Unlimited is $219/month for up to five, plus $29 per additional child after five. Unlimited plans include medically appropriate local visits. Prices are published rather than quoted privately, which is a deliberate contrast with the concierge convention.
Local in-person primary care is provided by Melissa Bennett, an adult-gerontology nurse practitioner, for ages 13 and older. Virtual care is available 24/7 from licensed providers. If a boutique physician-led retainer practice is specifically what you want, Presence is not that, and it is better to say so than to blur the categories.
Choosing between them
- Want enhanced access on top of good insurance, and price is not the issue? Concierge is a reasonable fit.
- Want primary care that is affordable without insurance billing? Direct primary care is the closer match.
- Want 24/7 virtual access as the backbone with local visits attached? That is the Presence structure.